Variable compression surgical fastener apparatus

ABSTRACT

A surgical fastener applying apparatus includes an anvil section and a cartridge section, where the cartridge section and the anvil section are movable from an unclamped position to a clamped position to clamp tissue therebetween. The cartridge section has a plurality of retention slots. A plurality of first surgical fasteners and a plurality of second surgical fasteners are disposed within a corresponding retention slot. The plurality of first surgical fasteners has a first backspan with a first configuration and the plurality of second surgical fasteners has a second backspan with a second configuration. The first configuration is different from the second configuration. In addition, when the first configuration applies a first compressive force to tissue upon formation of the plurality of first surgical fasteners and the second configuration applies a second compressive force to tissue upon formation of the plurality of second surgical fasteners, the second compressive force is different from the first compressive force.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to, and the benefit of U.S. ProvisionalPatent Application Ser. No. 61/051,911, filed on May 9, 2008, the entirecontents of which are hereby incorporated by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical fastener applying apparatus.More particularly, the present disclosure relates to a surgical fastenercartridge that includes a plurality of surgical fasteners configured toapply varying compressive forces to tissue.

2. Background of the Related Art

Many varieties of surgical fastening apparatus are known in the art,some of which are specifically adapted for use in various surgicalprocedures including, but not limited to, end-to-end anastomosis,circular end-to-end anastomosis, open gastrointestinal anastomosis,endoscopic gastrointestinal anastomosis, and transverse anastomosis.Suitable examples of apparatus which may be used during the course ofthese procedures can be seen in U.S. Pat. Nos. 5,915,616; 6,202,914;5,865,361; and 5,964,394.

In general, a surgical fastening apparatus will include an anvil that isapproximated relative to a fastener cartridge during use. The anvilincludes depressions that are aligned with, and/or are in registrationwith slots defined in the cartridge, through which the fasteners willemerge, to effectuate formation. Certain apparatus have fastenercartridges with one or more rows of fasteners disposed laterally orradially of a longitudinal slot that is configured to accommodate aknife, or other such cutting element, such that tissue can besimultaneously cut and joined together. Depending upon the particularsurgical fastening apparatus, the rows of fasteners may be arranged in alinear or non-linear, e.g. circular, semi-circular, or otherwise arcuateconfiguration.

Various types of surgical fasteners are well known in the art, includingbut not limited to unitary fasteners and two-part fasteners. Unitaryfasteners generally include a pair of legs adapted to penetrate tissueand connected by a backspan from which they extend. The staples areformed into a closed configuration, such as a “B” shaped configuration.Typically, the two-part fastener includes legs that are barbed andconnected by a backspan which are engaged and locked into a separateretainer piece that is usually located in the anvil. In use, thetwo-part fastener is pressed into the tissue so that the barbs penetratethe tissue and emerge from the other side where they are then lockedinto the retainer piece. The retainers prevent the two-part fastenerfrom dislodging from the tissue. The two-part fasteners are not intendedto be unlocked or removable. They are generally made of a bioabsorbablematerial.

During each of the aforementioned surgical procedures, the tissue isinitially gripped or clamped between the anvil and cartridge such thatindividual fasteners can be ejected from the cartridge, through theslots, and forced through the clamped tissue. Thereafter, the fastenersare formed by driving them into the depressions formed on the anvil.

A common concern in each of these procedures is hemostasis, or thecessation of bleeding of the target tissue. It is commonly known that byincreasing the amount of pressure applied to a wound, the flow of bloodcan be limited, thereby decreasing the time necessary to achievehemostasis. To this end, conventional surgical fastening apparatusgenerally apply two or more rows of fasteners about a cut-line tocompress the surrounding tissue in an effort to stop any bleeding and tojoin the cut tissue together. Each of the fasteners will generally applya compressive force to the tissue sufficient to effectuate hemostasis,however, if too much pressure is applied, this can result in a needlessreduction in blood flow to the tissue surrounding the cut-line.Accordingly, too much pressure in the joining of tissue together mayresult in an elevated level of necrosis, a slower rate of healing,and/or a greater recovery period.

Consequently, it would be advantageous to provide a surgical fasteningapparatus capable of limiting the flow of blood in the tissue toeffectuate hemostasis and wound closure, while maximizing blood flow inthe surrounding tissue to facilitate healing. Additionally, when tissueis clamped and compressed between the anvil and cartridge, differencesin the tissue can mean that portions of the tissue are thicker thanother portions of tissue. It would therefore be advantageous to providestaples which could better accommodate the different tissue thicknesses.

SUMMARY

The present disclosure is directed towards surgical stapling instrumentsconfigured to limit the flow of blood in tissue to effectuate hemostasisand wound closure, while maximizing blood flow in the surrounding tissueto facilitate healing. In particular, embodiments of the presentdisclosure include varying the formation of surgical fasteners in orderto vary the compressive force that is applied to surrounding tissue.Further still, when the surgical fasteners are formed within tissue,recesses in the backspans of the surgical fasteners cooperate with thelegs of the surgical fasteners to apply a compressive force tosurrounding tissue, whereby a varying of the recesses corresponds to avarying of the compressive forces applied to surrounding tissue.

A fastener assembly is disclosed herein for a surgical instrumentincluding a cartridge section and an anvil section, wherein thecartridge section and the anvil section are movable from an unclampedposition to a clamped position to clamp tissue therebetween. Thecartridge section has a plurality of retention slots disposed therein.In addition, a plurality of first surgical fasteners and a plurality ofsecond surgical fasteners are disclosed, wherein each surgical fasteneris disposed within a corresponding retention slot.

According to one aspect of the disclosure, the surgical fastenerapplying apparatus includes the plurality of first surgical fastenershaving a first backspan with a first configuration and the plurality ofsecond surgical fasteners having a second backspan with a secondconfiguration. According to this embodiment, the first configuration isdifferent from the second configuration. The first configuration isconfigured to apply a first compressive force to tissue upon formationof the plurality of the first surgical fasteners and the secondconfiguration is configured to apply a second compressive force totissue upon formation of the plurality of second surgical fasteners.According to this embodiment, the second compressive force is differentfrom the first compressive force.

In one embodiment, when the plurality of first surgical fasteners isformed, a plurality of first pushers disposed within the retention slotsmay form a recess in the first backspan of the first surgical fastenersto define the first configuration. In addition, when the plurality ofsecond surgical fasteners are formed, a plurality of second pushersdisposed within the retention slots may form a recess in the secondbackspan of the second surgical fasteners to define the secondconfiguration. The first recess may be different from the second recess.Further, as the anvil section and the cartridge section move from theunclamped position to the clamped position, the pressure applied tosurrounding tissue may correspond to the size of the recess in thecorresponding surgical fastener. Further still, the plurality of firstpushers and the plurality of second pushers may form the correspondingrecess in the corresponding backspan of the surgical fasteners atessentially the same time the surgical fasteners are driven against theanvil section.

According to another aspect of the present disclosure, the surgicalfastener applying apparatus includes an actuation sled that is capableof moving distally through the cartridge section. The actuation sled mayinclude at least one cam wedge. In addition, as the actuation sledtravels distally through the cartridge, the cam wedge is capable ofdriving the pushers in order to deploy the surgical fasteners and drivethem against the anvil section.

In another aspect of the present disclosure, the cartridge sectionincludes a longitudinal slot configured to allow longitudinal movementof a knife bar therethrough. The cartridge section can also include afirst inner row of retention slots and a first outer row of retentionslots on a first side of the longitudinal slot, and a second inner rowof retention slots and a second outer row of retention slots on a secondside of the longitudinal slot, wherein each retention slot is alignedwith a corresponding pusher and surgical fastener. In addition, thesurgical fasteners in the first inner row and the second inner row canbe formed with a bigger recess as compared to the surgical fasteners inthe first outer row and the second outer row. Accordingly, there wouldbe a smaller interior space within the surgical fasteners of the innerrows as compared to the outer rows of surgical fasteners. Moreover, agreater force would thus be applied to the tissue surrounding the innerrows as compared to the tissue surrounding the outer rows of surgicalfasteners.

In another embodiment, the actuation sled can include a first inner camwedge, a second inner cam wedge, a first outer cam wedge, and a secondouter cam wedge, wherein the first inner wedge contacts the pushers inthe first inner row of retention slots, the second inner cam wedgecontacts the pushers in the second inner row of retention slots, thefirst outer cam wedge contacts the pushers in the first outer row ofretention slots, and the second outer cam wedge contacts the pushers inthe second outer row of retention slots.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described hereinbelowwith references to the drawings, wherein:

FIG. 1 is a top, perspective view of a distal end portion of a surgicalfastener applying apparatus including a surgical fastener cartridge inaccordance with an embodiment of the present disclosure;

FIG. 2 is a side, perspective view of one embodiment of a surgicalfastener, including a substantially linear backspan, shown prior toformation, for use with the surgical fastener cartridge of FIG. 1;

FIG. 3 a is a cross-sectional view of a first surgical fastenersubsequent to formation and within adjacent tissue segments;

FIG. 3 b is a cross-sectional view of a second surgical fastenersubsequent to formation;

FIG. 3 c is a cross-sectional view of a third surgical fastenersubsequent to formation;

FIG. 3 d is a perspective view of a fourth surgical fastener subsequentto formation;

FIG. 4 is a plan view of a surgical fastener cartridge for a surgicalfastening apparatus according to an embodiment of the presentdisclosure;

FIG. 5 a is a partial cross-sectional view of a surgical fasteningapparatus according to an embodiment of the present disclosure;

FIG. 5 b is a partial cross-sectional view of a surgical fasteningapparatus according to an embodiment of the present disclosure;

FIG. 5 c is a perspective view of an actuation sled in accordance withan embodiment of the present disclosure;

FIG. 5 d is a perspective view of a pusher in accordance with anembodiment of the present disclosure;

FIG. 6 is a side, perspective view of an actuation structure for asurgical fastening apparatus according to an embodiment of the presentdisclosure;

FIG. 7 is a perspective view of an exemplary surgical fastener applyingapparatus in accordance with an embodiment of the present disclosure foruse during a laparoscopic surgical procedure;

FIG. 8 is a perspective view of surgical fastener applying apparatus inaccordance with an embodiment of the present disclosure;

FIG. 9 is a perspective view of a surgical fastener applying instrumentin accordance with an embodiment of the present disclosure;

FIG. 10 is a perspective view of a cartridge for a surgical fastenerapplying instrument in accordance with an embodiment of the presentdisclosure; and

FIG. 11 is a perspective view of a surgical fastener applying instrumentin accordance with an embodiment of the present disclosure.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

Various exemplary embodiments of the presently disclosed surgicalfastener cartridge will now be described in detail with reference to thedrawings wherein like references numerals identify similar or identicalelements. In the drawings and in the description which follows, the term“proximal” will refer to the end of the surgical fastener cartridge thatis closer to the operator during use, while the term “distal” will referto the end of the fastener cartridge that is further from the operator,as is traditional and conventional in the art. In addition, the term“surgical fastener” should be understood to include any substantiallyrigid structure formed of a biocompatible material that is suitable forthe intended purpose of joining tissue together, including but not beinglimited to surgical staples, clips, and the like. The surgical fastenercan be made of any biocompatible metal, such as titanium or stainlesssteel, or any biocompatible polymer, including absorbable or resorbablepolymers.

With reference to FIGS. 1 and 7, the surgical fastener applyingapparatus 1000 according to an embodiment of the present disclosure willbe discussed. Surgical fastener applying apparatus 1000 is used tosequentially apply a plurality of surgical fasteners, e.g., surgicalfasteners 130 to a patient's tissue, and may be of the re-usable ordisposable variety. Surgical fastener applying apparatus 1000 includes ahandle 1002, an elongated shaft 1004 extending distally therefrom, andan operative tool 1006 coupled to a distal end 1008 of the elongatedshaft 1004. (FIG. 7) The movable handle 1002 advances a drive roddistally to operate the operative tool 1006. However, other handles maybe used such as, for example, motor-driven, hydraulic, ratcheting, etc.In general, operative tool 1006 is adapted to clamp, sequentially fastentogether, and sever adjacent tissue segments along a cut-line.Accordingly, operative tool 1006 includes a pair of opposed jaws 1010,1012 pivotally coupled with respect to one another and respectivelyincluding an anvil member 1014 and a surgical fastener cartridge 100.

In operation, surgical fastener applying apparatus 1000 is firedsimilarly to and in accordance with other known surgical staplinginstruments. For a detailed discussion of the approximation and firingof surgical stapling instrument 1000, reference is made to commonlyassigned U.S. Pat. No. 5,865,361, currently assigned to Tyco HealthcareGroup LP, the entire contents of which is hereby incorporated herein byreference. The handle assembly 1002 includes a housing 1016, whichincludes stationary handle member 1018. A movable handle 1020 ispivotably supported within the housing 1016 and is biased away from thestationary handle member 1018. Movement of the movable handle 1020 inthe direction of the stationary handle member 1018 imparts a drivingforce to an actuation shaft within the housing 1016 causing it toadvance linearly in a distal direction. The anvil member 1014 and thestaple cartridge 100 are moved closer relative to each other and a forceis transmitted to the ejectors or pushers positioned adjacent tosurgical fasteners 130 disposed within slots of the staple cartridge 100thereby ejecting the surgical fasteners 130 and driving the surgicalfasteners 130 against a staple forming surface of the anvil member 1014.

Surgical fastener cartridge 100 extends along a longitudinal axis “A-A”and includes a cartridge body 112 with a pair of side walls 114, 116, abottom wall 118, and a top wall 120. (FIG. 1) The cartridge body 112includes a longitudinal slot 122 that is configured to accommodatelongitudinal movement of a knife (not shown) or other cutting elementsuch that tissue may be severed along a cut-line. The top wall 120further includes a tissue engaging surface 124, e.g., for engaging thetissue to be cut, and a plurality of fastener retention slots 126arranged perpendicularly, or generally transversely, with respect to thelongitudinal axis A-A in a pattern that extends substantially the entirelength of the cartridge 100. As shown in FIG. 1, a first inner row 128Aof slots 126 and a first outer row 128B of slots are formed on a firstside of the longitudinal slot 122 and, on an opposite side of thelongitudinal slot 122, the cartridge 100 has a second inner row 128 c ofslots and a second outer row 128D of slots. While the cartridge 100 isdepicted as including pairs of rows on either side of the longitudinalslot 122, additional rows of fastener retention slots 126 may beincluded in additional embodiments of the cartridge 100. Cartridge 100in preferred embodiments is removable and replaceable with anotherloaded cartridge, or forms part of a removable and replaceable loadingunit.

Each of the fastener retention slots 126 is configured to receive one ofa plurality of surgical fasteners and pushers therein such that thesurgical fasteners are deployed in rows, on opposite sides ofthe-cut-line created in the tissue during fastening. The initialconfiguration of the surgical fasteners is as shown in FIG. 2, or anyother generally open configuration. The surgical fastener has a backspanand a pair of legs extending generally perpendicularly from the backspansuch as, for example, surgical fastener 130 having backspan 134 and legs132. The dimensions of the backspan 134 and the legs 132 can be variedsuch that the surgical fastener 130 may be used to fasten adjacenttissue segments “T1”, “T2” of any thickness. (See FIG. 3 a).

The cartridge 100 includes an actuation sled 1134 that translatesdistally through the cartridge 100. The actuation sled 1134 is drivendistally by a drive bar 1107, as shown in FIG. 5 a, that is actuated bythe handle 1002. The sled 1134 includes cam wedges that contact thepushers 1131 and drive the pushers 1132 upwardly to deploy the surgicalfasteners 130 and drive them against the anvil member 1014. (FIG. 5 c)In certain embodiments, the cartridge 100 has a sled 1134 with a firstinner wedge 1135, a second inner wedge 1130, a first outer wedge 1133,and a second outer wedge 1137. The first inner wedge 1135 contacts thepushers in the first inner row 128A of fastener retention slots 126, thesecond inner wedge contacts the pushers in the second inner row 128C ofretention slots 126, the first outer wedge contacts the pushers in thefirst outer row 128B of retention slots 126, and the second outer wedgecontacts the pushers in the second outer row 128D of retention slots126. The cam wedges 1135 are integrally formed with one another, orattached to one another, as shown in FIG. 5 c.

The first and second inner wedges, 1135, 1130, that contact the pushersin the first and second inner row of slots, each have wedge surfaces1135 a and 1135 b, defining a crimping wedge surface, and a furtherdimpling wedge surface 1135 c. The crimping wedge surface 1135 a and1135 b is disposed on the cam wedge of the sled 1134 so that it isdisposed distally of the dimpling wedge surface 1135 c. Thecorresponding pusher has a crimping pusher 1132 and a dimpling pusher1138 that is slidable with respect to the crimping pusher 1132 as shownin FIG. 6. As the sled 1134 is driven distally by the drive bar 107, thecrimping wedge surface contacts a crimping pusher 1132 first, drivingthe surgical fastener against the anvil member 1014. The dimpling wedgesurface 1135 c then comes into contact with the dimpling pusher 1138.The surgical fastener, being still captured between the cartridge andanvil member, is engaged by the dimpling pusher 1138 and a recess 116 isformed in the backspan of the surgical fastener, as shown in FIGS. 3 band 5 b.

As shown in FIG. 6, the dimpling pusher 1138 can be formed as a rodreceived in a passage 1132 c in the crimping pusher 1132. The dimplingwedge surface 1135 c can be formed in the middle of the cam wedge of thesled 1134, with the crimping wedge surface 1135 a and 1135 b straddlingthe dimpling wedge surface. In other embodiments, a crimping wedgesurface may be formed on one side of the cam wedge, with the dimplingwedge surface formed on the other side of the cam wedge and thecorresponding pusher is arranged accordingly.

The first and second outer wedges, 1133, 1137, that contact the pushersin the first and second outer row of slots, each have a single wedgesurface 1139. These wedge surfaces of the first and second outer wedgesinteract with a corresponding pusher. As the sled 1134 is drivendistally by the drive bar 107, the wedge surfaces contact thecorresponding pusher, driving the surgical fastener against the anvilmember 1014. The anvil member has recesses shaped to deform the surgicalfastener to a configuration that is generally closed. For example, thesurgical fasteners can be deformed to the B-shaped configuration shownin FIG. 3 a, the rectangular configuration of FIG. 3 c, or any otherconfiguration. There is no dimpling of the backspan of the surgicalfasteners in the outer rows of slots in the cartridge 100 in thisembodiment. In certain preferred embodiments, it is desirable that thesurgical fasteners of the inner rows of slots have a smaller interiorspace, compressing tissue more, than the surgical fasteners of the outerrows of slots.

In a further embodiment, the surgical fastener cartridge has pushers inthe inner rows of slots that each has a crimping pusher and a dimplingpusher that are integrally formed, as shown in FIG. 5 d. The dimplingpusher 1201 has an upper surface 1203 that extends above an uppersurface 1205 of the crimping pusher 1207. As the sled travels throughthe cartridge distally, the pusher 1200 closes the surgical fastener andforms a recess in the backspan of the surgical fastener at essentiallythe same time. The wedge of the sled that corresponds to these pushershas a single wedge surface for driving the pusher 1200. The pushers inthe outer rows of slots are as discussed above, to form surgicalfasteners with a different formed configuration. In certain embodiments,it is desirable that the surgical fasteners of the inner rows of slotshave a smaller interior space than the surgical fasteners of the outerrows of slots. The surgical fastener cartridge may have slots arrangedtransversely or generally perpendicular to the longitudinal axis of thecartridge, or the slots may be generally parallel to the longitudinalaxis of the cartridge.

In a further embodiment, the surgical fastener cartridge has pusherswith a collapsible portion. After the initial formation of the surgicalfastener, the collapsible portion fails. This allows a portion of thepusher to continue to be advanced, forming a dimple or recess in aportion of the backspan of the surgical fastener.

In further embodiments, one or more of the cam wedges are separatelyactuable by the handle. For example, the handle may include more thanone movable handle arm that are each connected to a driving rod. Eachmovable handle arm can be manipulated by the user to drive a driving rodthat interacts with one of the cam wedges. In this way, one or more rowsof surgical fasteners can be separately deployed.

In another embodiment, pushers having dimpling pushers are provided atthe distal end of a row of surgical fasteners, whereas the remainingpushers in the row do not have dimpling pushers. The surgical fastenersat the distal end of the row have a formed configuration that includes arecess and may have a smaller interior space when formed than theremaining fasteners in the row. In other examples, pushers havingdimpling pushers are provided at the proximal end and/or intermediateregion of a row of surgical fasteners, whereas the remaining pushers inthe row do not have dimpling pushers, to form some surgical fastenerswith recesses and relatively smaller interior spaces than the remainingsurgical fasteners.

The legs 132 and the backspan 134 of the surgical fasteners may define across-section having any suitable geometric configuration, including butnot being limited to rectangular, circular oval, square, triangular,trapezoidal, etc. The legs 132 and the backspan 134 may exhibit the samegeometrical configuration such that the cross-sectional configuration ofthe surgical fastener 130 is substantially uniform, as shown in FIG. 2,or alternatively, the legs 132 and the backspan 134 may exhibitdifferent width or geometrical configurations, e.g., the legs 132 mayexhibit a rectangular cross-section whereas the backspan 34 may exhibitan oval cross-section.

Prior to the formation of surgical fastener 130, the legs 132 extendfrom the backspan 134 such that they are substantially parallel. In thealternative, the legs 132 may not extend from the backspan 134 in aparallel arrangement, i.e., the legs 132 may converge or diverge fromthe backspan. The present disclosure contemplates that the surgicalfastener 130 may also be configured as a directionally biased surgicalfastener, such as those described in U.S. Pat. No. 7,398,907, the entirecontents of which are incorporated by reference herein. The surgicalfasteners are formed of a deformable material such as stainless steel,titanium or deformable polymers.

Each of the legs 132 terminates in a penetrating end 136 that isconfigured to penetrate tissue, e.g., tissue segments “T1”, “T2”. (SeeFIG. 3 a). The penetrating ends 136 of legs 132 can be tapered tofacilitate the penetration of tissue segments “T1”, “T2”, oralternatively, the penetrating ends 136 may not include a taper. Invarious embodiments of the surgical fastener 130, the penetrating ends136 may define a conical or flat surface, as described in co-pendingU.S. patent application Ser. No. 11/444,761, published as U.S. PatentApplication Publication No. 20060291981, filed Apr. 13, 2003, the entirecontents of which are incorporated by reference herein.

In the embodiment of the surgical fastener 130 illustrated in FIG. 2,the backspan 134 is substantially linear in configuration, in theundeformed state. When formed in tissue segments “T1”, “T2”, the legs132 of the surgical fastener 130 may be curved toward one another andpoint toward the backspan, in the shape of the letter “B,” as shown inFIG. 3 a. The legs 132 cooperate with the backspan 134 to maintainadjacent tissue segments “T1”, “T2” in approximation and apply acompressive force “F” thereto. The compressive force “F” appliespressure to the tissue segments “T1”, “T2”, thereby restricting the flowof blood through the tissue surrounding the surgical fastener 130 andfacilitating hemostasis. After formation, the staple has a closedconfiguration, with an interior space between the backspan 134 and legs132 that limits the amount of pressure that is applied to the tissuesegments “T1”, “T2” such that the flow of blood through the tissue isnot completely restricted. When formed, the surgical fastener 130defines an overall height “Hf”, measured from the backspan 134 to theoutermost curve of the legs 132.

FIGS. 3 a, 3 b, 3 c, and 3 d illustrate alternate formed configurationsfor the fastener. Cartridges and surgical fastening apparatus accordingto the present disclosure use fasteners that are formed in a combinationof one or more formed configurations. The formed configuration of thesurgical fasteners can vary from row to row within the cartridge, or canvary within rows within the cartridge. Generally, the surgical fasteningapparatus includes actuating structure to form one or more recesses inthe backspan of certain surgical fasteners such that the backspan issubstantially non-linear in configuration. When formed, the non-linearconfiguration of the backspan reduces the interior space of the formedsurgical fastener and further restricts the flow of blood through thetissue surrounding the surgical fastener, as discussed in further detailbelow. It may be desirable to apply greater pressure to certain portionsof tissue joined by the surgical fastening apparatus, as compared toother portions of tissue, or to account for differences in the thicknessof tissue portions engaged by the surgical fastening apparatus.

The surgical fastener shown in FIG. 3 b has a single recess 116 or humpformed in the backspan of the surgical fastener. By contrast, thesurgical fastener shown in FIG. 3 c has no recess or hump, and the legsdo not have the curved B-shape configuration shown in FIG. 3 a. FIG. 3 dshows a surgical fastener having two recesses 138A in the backspan ofthe surgical fastener. The actuation structure will include two dimplingpushers to engage the backspan of the surgical fastener.

Referring to FIG. 3 d, a surgical fastener 130 a is shown in its formedcondition. The surgical fastener 130 a includes recesses 138 a formed inthe backspan 134 a that extend inwardly therefrom, curving towards thepenetrating ends 136 of the legs 132 and defining a recess or hump of afirst height “H1”. When the surgical fastener 130 a is formed withintissue segments “T1”, “T2” the humps/recesses 138 a cooperate with thelegs 132 of the surgical fastener 130 a to apply a compressive forcethereto. The compressive force applied by the surgical fastener 130 a isgreater than the compressive force applied by surgical fastener 130(FIG. 3 a), as the interior space, or compressive space, which isdefined between the backspan 134A and the legs 132 and occupied by thetissue segments “T1”, “T2” is less in the surgical fastener 130 a whencompared to the compressive space occupied by the tissue segments “T1”,“T2” in the surgical fastener 130 (FIG. 3 a). Accordingly, greaterpressure is applied to the tissue segments “T1”, “T2” by surgicalfastener 130 a. Consequently, the flow of blood through the tissuesurrounding the surgical fastener 130 a is more restricted when comparedto the flow of blood through the tissue surrounding surgical fastener130, thereby further facilitating hemostasis. The dimensions of therecesses 138 a and the compressive space occupied by the tissue segments“T1”, “T2” are such that blood flow is not completely restricted,however, thereby preventing any unnecessary necrosing of tissue. Whenformed, the surgical fastener 130 a may define an overall height “Hf”that is substantially equal to that defined by the surgical fastener130.

In a further example, the recesses or humps formed in the backspan ofthe staples can be varied to vary the interior space or compressivespace of the formed staple, to compress certain portions of tissue moreas compared to other portions of tissue joined by the surgical fasteningapparatus. In an embodiment, for example, the surgical fastenercartridge forms surgical fasteners with smaller recesses in the firstand second outer rows of slots and surgical fasteners with comparativelylarger recesses in the first and second inner rows of slots.Accordingly, when the surgical fastener is formed within tissue segments“T1”, “T2”, the recesses cooperate with the legs of the surgicalfastener to apply a compressive force thereto. The compressive forceapplied by the surgical fastener with the larger recesses is greaterthan the compressive forces applied by the surgical fasteners with thesmaller recesses, as the compressive space occupied by the tissuesegments “T1”, “T2” is less. When formed, the surgical fasteners definean overall height “Hp” that that may be substantially equal.

In the embodiment shown in FIG. 1, the surgical fasteners installedwithin the cartridge body 112 are arranged to define a pair of innerrows and a pair of outer rows that correspond to the respective innerand outer rows of fastener retention slots 126 formed in the top wall120. Accordingly, the pair of inner rows are spaced laterally from thelongitudinal slot 122, on opposite sides thereof, and the pair of outerrows are spaced laterally from the pair of inner rows, again on oppositesides of the longitudinal slot 122 such that the surgical fasteners willbe deployed on opposite sides of the cut-line (not shown) created in thetissue upon fastening. That is, the fasteners with the recesses 116(FIG. 3 b) provide a greater compressive force as there is a shorterdistance between the curve (hump) of the recess and the curve of theformed legs, the fasteners have a smaller interior space, and in theillustrated embodiment these fasteners are provided in the inner rowscloser to the cut line. The fasteners with a greater distance betweenthe curve of the legs and the backspan and are provided on the outerrows. If a third row of fasteners is used in this embodiment, then thefasteners with the smallest interior space (such as, for example,fasteners with relatively large recesses) would preferably be placed onthe innermost rows closest to the cut line. By providing the rows offasteners which provide greater tissue compression as you approach thecut line, tissue is compressed more adjacent the cut line. It should beappreciated however, that the fasteners can be placed in otherarrangements in the rows than the foregoing arrangement. Also, thepresent disclosure contemplates the use of any of the surgical fastenersdisclosed herein such that a surgical fastener with only a single formedconfiguration, e.g., surgical fastener 130, is present, or surgicalfasteners with a variety of formed configurations are used.

While surgical fastener applying apparatus 1000 is depicted as anapparatus suitable for use in laparoscopic procedures for performingsurgical anastomotic fastening of tissue, it should be understood thatsurgical fastener cartridge 100 may be adapted for use with any surgicalinstrument suitable for the intended purpose of applying surgicalfasteners to tissue. For example, surgical fastener cartridge 100 may beadapted for use with an end-to-end anastomosis device 2000, as seen inFIG. 8, a surgical fastener applying instrument 3000, as seen in FIG. 9,for use during an open gastro-intestinal anastomotic fasteningprocedure, or any of the surgical fastener applying apparatus discussedin U.S. Pat. Nos. 6,045,560; 5,964,394; 5,894,979; 5,878,937; 5,915,616;5,836,503; 5,865,361; 5,862,972; 5,817,109; 5,797,538; and 5,782,396,which are each incorporated by reference herein in their entirety.

The surgical stapling apparatus 3000 includes a cartridge receivinghalf-section 3002, which accommodates a plurality of surgical fasteners,and an anvil half-section 3004. The half-sections 3002, 3004 arepivotally connected via handles 3006, 3008 for approximation during use.Following approximation of the half-sections 3002, 3004, the surgicalfastener applying apparatus 3000 is fired by driving a firing slidedistally through the advancement of a firing lever 3012. Distal movementof the firing slide causes a plurality of cam bars to engage cammingsurfaces that interact with a plurality of pushers to expel theplurality of surgical fasteners from the cartridge receivinghalf-section 3002. The surgical fasteners are positioned on either sideof a track which guides a knife during longitudinal movement to therebysever tissue along a cut-line.

Referring now to FIG. 10, in an alternate embodiment, a surgicalfastener cartridge 200 is disclosed. Surgical fastener cartridge 200 issimilar to surgical fastener cartridge 100 in that it contains rows offasteners, however it does not have a longitudinal slot 122 (FIG. 1)configured to accommodate a knife or other cutting element (although inalternate embodiments, a knife could be provided). As with surgicalfastener cartridge 100, surgical fastener cartridge 200 includes aplurality of fastener retention slots 226 on a top wall 220 of cartridgebody 212 that are arranged into a plurality of rows 228. The rows 228 ofretention slots 226 are spaced laterally from a centerline 252 extendingalong the longitudinal axis “A-A” defined by cartridge body 212 andpreferably spaced equidistant from sidewalls 214, 216. As shown, theplurality of rows 228 includes a pair of first (inner) rows 228 adisposed on opposite sides of centerline 252 and a pair of second(outer) rows 228 b spaced laterally from the pair of first rows 228 a,again on opposite sides of the centerline 252. Each of the slots extendgenerally parallel to the longitudinal axis. Each of the fastenerretention slots 226 is configured to receive one of a plurality ofsurgical fasteners and pushers (not shown) such that the surgicalfasteners are deployed in rows, e.g., inner and outer rows in theembodiment of FIG. 18, on opposite sides of the centerline 252 andformed into fasteners having one or more formed configurations, e.g.,surgical fasteners shown in FIGS. 3 a, 3 b, 3 c, 3 d.

FIG. 4 shows an example of a surgical fastener cartridge 2220 havingslots 2224, formed in the upper surface 2222 of the cartridge. The slotsextend generally perpendicularly to the longitudinal axis. These slots2224 are arranged in columns, such as column 2227 and rows 2228. Thiscartridge 2220 does not include a longitudinal slot for a knife. Thecartridge 2220 includes a plurality of pushers as discussed herein forforming certain of the fasteners with a relatively large interior space,and other fasteners with a relatively small interior space.

Although the surgical fastener cartridge 200 of FIG. 10 is depicted asincluding pairs of first and second rows 228 a, 228 b, respectively,additional rows of fastener retention slots 226, and accordingly,additional rows of surgical fasteners, may be included in alternateembodiments of the surgical fastener cartridge 200, as discussed abovewith respect to surgical fastener cartridge 100. Also, the fasteners maybe arranged in differing fashions within the cartridge as discussedherein with respect to the other cartridge embodiments.

With additional reference to FIG. 11, a surgical fastener applyingapparatus 4000 of either the re-usable or disposable variety isillustrated for use with the surgical fastener cartridge 200. Surgicalfastener applying apparatus 4000 includes a handle assembly 4002, anelongated portion 4004 extending distally from the handle 4002, and anarm 4006 extending from a distal end 4008 of the elongated portion 4004.The surgical fastener applying apparatus 4000 further includes an endeffector 4010 including an anvil 4012 orthogonally affixed to arm 4006and a surgical fastener cartridge receiver 4014 operatively coupled tothe distal end 4008 of elongated portion 4004 for holding the surgicalfastener cartridge 200 thereon.

In operation, surgical fastener applying apparatus 4000 is firedsimilarly to and in accordance with other known surgical staplinginstruments. For a detailed discussion of the approximation and firingof surgical stapling instrument 4000, reference is made to commonlyassigned U.S. Pat. No. 5,964,394, currently assigned to Tyco HealthcareGroup LP, the entire contents of which is incorporated herein byreference. The handle assembly 4002 includes a housing 4016, whichincludes a stationary handle member 4018. A movable handle 4020 ispivotably supported within the housing 4016 and is biased away from thestationary handle member 4018. Movement of the movable handle member4020 in the direction of the stationary handle member 4018 imparts adriving force to an actuation shaft within the housing 4016 which inturn imparts a force to a pusher bar within the staple cartridge 4014 tothereby eject fasteners disposed within slots of the staple cartridge200 and to drive the surgical fasteners against a staple forming surfaceof the anvil member 4012. Prior to advancing the staple cartridge 4014towards the anvil 4012, the physician moves an approximation lever 4017towards the housing 4016 which causes the staple cartridge 4014 to movetowards anvil 4012 prior to firing the staples and approximating thestaple cartridge 4014 relative to the anvil 4012 with tissue disposedtherebetween.

Surgical fastener applying apparatus 4000 is used to apply a pluralityof surgical fasteners, e.g., surgical fasteners 130 to either side of atarget section of tissue (not shown), and may be any surgical fastenerapplying apparatus suitable for this intended purpose, including but notbeing limited to the transverse anastomosis fastening instrumentdisclosed in U.S. Pat. No. 7,070,083, the entire contents of whichhaving been previously incorporated by reference herein. The fastenerapplying apparatus has a plurality of pushers that are advanced in thedistal direction to deploy the surgical fasteners from the cartridge, inthe distal direction, against the anvil. The surgical fasteners aregenerally deployed and formed simultaneously. To form surgical fastenerswith different formed configurations (e.g., as shown in FIGS. 3 a, 3 b,3 c, 3 d) as compared to other surgical fasteners in the cartridge, someof the pushers have a dimpling pusher and a crimping pusher. Thedimpling pusher and crimping pusher may be movable with respect to oneanother, to separately close the surgical fastener and then form arecess in the backspan of the surgical fastener, or the dimpling pusherand crimping pusher may be integrally formed with one another.Thereafter, a scalpel or other such cutting element may be used toremove the target section of tissue. Further details regarding the useand function of surgical fastener applying apparatus 4000 may beobtained through reference to U.S. Pat. No. 7,070,083. In an alternateembodiment, the apparatus 4000 could include a cutting element as in theother cartridges disclosed herein.

The surgical fastener applying apparatus according to certainembodiments of the present disclosure include a plurality of cam barsfor interacting with the pushers to deploy the surgical fasteners. Forexample, the apparatus disclosed in U.S. Pat. No. 5,318,221, thedisclosure of which is hereby incorporated by reference herein, in itsentirety, has a cam bar adapter that holds a plurality of cam bars and aknife. A channel is advanced through operation of the handle of theapparatus, which drives the cam bars and knife forward. A clamp tubethat surrounds the proximal end of the anvil is advanced to clamp theanvil and cartridge together. In another example, the apparatusdisclosed in U.S. Pat. No. 5,782,396, the disclosure of which is herebyincorporated by reference herein, in its entirety, has an actuationsled. An elongated drive beam is advanced distally through operation ofthe handle of the apparatus, driving the actuation sled forward. Thedistal end of the drive beam engages the anvil and the channel thatsupport the cartridge as the drive beam travels distally, to deploy thestaples and clamp the anvil and cartridge together.

The present disclosure contemplates a surgical stapling apparatus havinga surgical fastener cartridge with an upper surface defining a pluralityof slots, the slots being arranged in a first inner row and a firstouter row, each slot in the first inner row containing a first innersurgical fastener and a pusher having a crimping pusher and a dimplingpusher arranged to form the first inner surgical fastener in a firstclosed configuration and to form a recess in a backspan of the surgicalfastener, each slot in the first outer row containing a first outersurgical fastener and a pusher arranged to form the first outer surgicalfastener in a second formed configuration.

The present disclosure further contemplates a surgical staplingapparatus having a surgical fastener cartridge with an upper surfacedefining a plurality of slots, the slots being arranged in a first innerrow and a first outer row, each slot in the first inner row containing afirst inner surgical fastener and a pusher arranged to form the firstinner surgical fastener so that the formed first inner surgical fastenerhas a first interior space and a backspan that is deformed, each slot inthe first outer row containing a first outer surgical fastener and apusher arranged to form the first outer surgical fastener so that theformed first outer surgical fastener has a second interior space, thefirst interior space being smaller than the second interior space.

It should be understood that the present disclosure is not limited tothe precise embodiments discussed herein above, and that various otherchanges and modifications may be contemplated by one skilled in the artwithout departing from the scope or spirit of the present disclosure.For example, the surgical fasteners described herein above may be formedfrom a variety of surgically acceptable materials including titanium,plastics, bio-absorbable materials, etc. Although the illustrativeembodiments of the present disclosure have been described herein withreference to the accompanying drawings, the above description,disclosure, and figures should not be construed as limiting, but merelyas exemplary of various embodiments.

1. A surgical fastener applying apparatus comprising: a fastenerassembly including an anvil section and a cartridge section, thecartridge section and the anvil section movable from an unclampedposition to a clamped position to clamp tissue therebetween, thecartridge section having a tissue contacting surface with a plurality ofretention slots formed therein; a plurality of first surgical fastenersand a plurality of second surgical fasteners retained within thecartridge section, each surgical fastener disposed within acorresponding retention slot, the plurality of first surgical fastenershaving a first backspan and the plurality of second surgical fastenershaving a second backspan; a plurality of first pushers and a pluralityof second pushers positioned within the cartridge section; and anactuation member movable through the cartridge section and engagablewith the plurality of first pushers and the plurality of second pushersto move the plurality of first pushers and the plurality of secondpushers towards the tissue contacting surface of the cartridge section,the plurality of first pushers being configured and dimensioned todeform the first backspan from an initial configuration into asubsequent configuration such that the plurality of first surgicalfasteners apply a first compressive force to tissue upon formation, theplurality of second pushers being configured and dimensioned to deformthe second backspan from an initial configuration into a subsequentconfiguration such that the plurality of second surgical fasteners applya second compressive force to tissue upon formation, the secondcompressive force being different than the first compressive force. 2.The surgical fastener applying apparatus according to claim 1, whereinthe plurality of first pushers are configured and dimensioned to form afirst recess in the first backspan of the plurality of first surgicalfasteners to define the subsequent configuration, and the plurality ofsecond pushers are configured and dimensioned to form a second recess inthe second backspan of the plurality of second surgical fasteners todefine the subsequent configuration.
 3. The surgical fastener applyingapparatus according to claim 2, wherein the first recess is differentfrom the second recess.
 4. The surgical fastener applying apparatusaccording to claim 2, wherein as the anvil section and the cartridgesection move from the unclamped position to the clamped position,pressure applied to surrounding tissue corresponds to a size of thefirst and second recesses.
 5. The surgical fastener applying apparatusaccording to claim 2, wherein the plurality of first pushers areconfigured, dimensioned, and positioned to deform the plurality of firstsurgical fasteners upon engagement of the plurality of first surgicalfasteners with the anvil section, and the plurality of second pushersare configured, dimensioned, and positioned to deform the plurality ofsecond surgical fasteners upon engagement of the plurality of secondsurgical fasteners with the anvil section.
 6. The surgical fastenerapplying apparatus according to claim 1, wherein the actuation memberincludes at least one cam wedge.
 7. The surgical fastener applyingapparatus according to claim 6, wherein the at least one cam wedge isconfigured and dimensioned for engagement with the plurality of firstpushers and the plurality of second pushers to facilitate ejection ofthe plurality of first surgical fasteners and the plurality of secondsurgical fasteners from the cartridge section into the anvil section. 8.The surgical fastener applying apparatus according to claim 2, whereinthe cartridge section includes a longitudinal slot configured to allowlongitudinal movement of a knife bar therethrough to create a cut linein the tissue.
 9. The surgical fastener applying apparatus according toclaim 8, wherein the cartridge section includes a first inner row ofretention slots and a first outer row of retention slots on a first sideof the longitudinal slot, and a second inner row of retention slots anda second outer row of retention slots on a second side of thelongitudinal slot, the plurality of first surgical fasteners and theplurality of first pushers being arranged into a pair of inner rowswithin the cartridge section such that the plurality of first surgicalfasteners are ejected through the inner rows of retention slots by theplurality of first pushers, the plurality of second surgical fastenersand the plurality of second pushers being arranged into a pair of outerrows within the cartridge section such that the plurality of secondsurgical fasteners are ejected through the outer rows of retention slotsby the plurality of second pushers.
 10. The surgical fastener applyingapparatus according to claim 9, wherein the plurality of first pushersare configured and dimensioned such that the first recess is larger thanthe second recess, whereby a greater force is applied to the tissuecloser to the cut line.
 11. The surgical fastener applying apparatusaccording to claim 7, wherein the at least one cam wedge includes innercam wedges and outer cam wedges the inner cam wedges being configuredand dimensioned for engagement with the plurality of first pushers, andthe outer cam wedges being configured and dimensioned for engagementwith the plurality of second pushers.
 12. A surgical instrumentcomprising: an elongate shaft; and a tool assembly operatively securedto a distal end of the elongate shaft, the tool assembly including ananvil member having a tissue contacting surface, and a cartridge memberpivotally connected to the anvil member and having a tissue contactingsurface, the cartridge member defining a central longitudinal axis, andincluding: a plurality of first surgical fasteners arranged into aplurality of inner rows positioned on opposite sides of the centrallongitudinal axis of the cartridge member, the plurality of firstsurgical fasteners each including a pair of legs connected by abackspan; a plurality of second surgical fasteners arranged into aplurality of outer rows positioned on opposite sides of the centrallongitudinal axis of the cartridge member, the plurality of secondsurgical fasteners each including a pair of legs connected by abackspan; a plurality of first pushers configured and dimensioned forengagement with the plurality of first surgical fasteners to eject theplurality of first surgical fasteners from the cartridge member into theanvil member for formation; a plurality of second pushers configured anddimensioned for engagement with the plurality of second surgicalfasteners to eject the plurality of second surgical fasteners from thecartridge member into the anvil member for formation; and an actuationmember movable through the cartridge section and engagable with theplurality of first pushers and the plurality of second pushers to movethe plurality of first pushers and the plurality of second pusherstowards the tissue contacting surface of the cartridge member, theplurality of first pushers being configured and dimensioned to deformthe backspans of the plurality of first surgical fasteners from aninitial configuration into a subsequent configuration such that theplurality of first surgical fasteners apply a first compressive force totissue upon formation, and the plurality of second pushers beingconfigured and dimensioned to deform the backspans of the plurality ofsecond surgical fasteners from an initial configuration into asubsequent configuration such that the plurality of second surgicalfasteners apply a second compressive force to tissue upon formation, thesecond compressive force being different than the first compressiveforce.
 13. The surgical instrument according to claim 12, wherein theplurality of first pushers are configured and dimensioned to form afirst recess in the backspan of the plurality of first surgicalfasteners during formation, and the plurality of second pushers areconfigured and dimensioned to form a second recess in the backspan ofthe plurality of second surgical fasteners during formation.
 14. Thesurgical instrument according to claim 13, wherein the plurality offirst pushers and the plurality of second pushers are configured anddimensioned such that the configuration and dimensions of the firstrecesses are different from the configuration and dimensions of thesecond recesses.
 15. The surgical instrument according to claim 12,wherein the actuation member includes inner cam wedges and outer camwedges, the inner cam wedges being configured and dimensioned forengagement with the plurality of first pushers, and the outer cam wedgesbeing configured and dimensioned for engagement with the plurality ofsecond pushers.
 16. The surgical instrument according to claim 12,wherein the plurality of first pushers and the plurality of secondpushers each include a first pusher element and a second pusher element.17. The surgical instrument according to claim 16, wherein the firstpusher element is configured and dimensioned to receive the secondpusher element such that the second pusher element is movable throughthe first pusher element.
 18. The surgical instrument according to claim17, wherein the actuation member includes a first surface configured anddimensioned to engage the first pusher element, and a second surfaceconfigured and dimensioned to engage the second pusher element, thefirst surface extending along a first axis, and the second surfaceextending along a second axis intersecting the first axis.
 19. Thesurgical instrument according to claim 16, wherein the first pusherelement and the second pusher element are integrally formed.
 20. Thesurgical instrument according to claim 19, wherein the first pusherelement defines a first height, and the second pusher element defines asecond, different height.